Stress Fractures in Military Recruits: Current Concepts, Risk Stratification, Prevention, Evidence-Based Management, and Future Directions
- 1Department of Orthopaedic Surgery, Security Forces Hospital, Riyadh, SAU
Abstract
Stress fracture is a major cause of morbidity, training loss, retarded graduation, and military loss in recruits where there is an abrupt increase in repetitive mechanical loading. This narrative review synthesized up-to-date data on mechanobiology, risk factors, risk stratification, clinical signs and symptoms, diagnosis, prevention, management, rehabilitation, return to duty, and future directions for stress fracture in military populations. A literature search in PubMed/MEDLINE and Google Scholar identified 35 English-language studies used in the final narrative synthesis.
Existing data indicate a load-capacity model involving dynamic relationships among external mechanical dose, local skeletal strain, and biological repair capacity. Factors contributing to susceptibility are a history of stress fracture, being female, age, menstrual malfunction, pre-entry conditioning, poor body composition, lack of vitamin D, exposure to medication, and site-specific biomechanics. In cases of negative radiographs and a high rate of clinical suspicion, such as activity-related and localized early symptoms, advanced imaging, including MRI, is the choice. Implement site-specific management, with greater protection and surgical attention for high-risk fractures. Rehabilitation should depend on pain-free work, strength recovery, progressive exposure to impact, and signs of healing rather than time.
Prevention should focus on pre-entry conditioning, gradual training loads, adequate rest, adequate nutrition, and early symptom reporting. Future studies should test dynamic prediction models that integrate skeletal imaging, load measures from wearables, and known fracture outcomes to inform prevention and safe return to military service at the individual level.
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BibTeX
@article{alrumaih2026stress,
title = {{Stress Fractures in Military Recruits: Current Concepts, Risk Stratification, Prevention, Evidence-Based Management, and Future Directions}},
author = {Mohammed Al-Rumaih and Waleed Al-Hoshan and Mansour Al-Jahny and Talal Al-Malki and Abdulrahman Al-Otaibi and Meshari Al-Shayie and Abdulmajeed Al-Wayil and Salman Al-Harbi},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117517},
url = {https://doi.org/10.7759/cureus.117517},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stress Fractures in Military Recruits: Current Concepts, Risk Stratification, Prevention, Evidence-Based Management, and Future Directions
AU - Mohammed Al-Rumaih
AU - Waleed Al-Hoshan
AU - Mansour Al-Jahny
AU - Talal Al-Malki
AU - Abdulrahman Al-Otaibi
AU - Meshari Al-Shayie
AU - Abdulmajeed Al-Wayil
AU - Salman Al-Harbi
PY - 2026
DA - 2026/10/05
JO - Cureus
DO - 10.7759/cureus.117517
UR - https://doi.org/10.7759/cureus.117517
AB - Stress fracture is a major cause of morbidity, training loss, retarded graduation, and military loss in recruits where there is an abrupt increase in repetitive mechanical loading. This narrative review synthesized up-to-date data on mechanobiology, risk factors, risk stratification, clinical signs and symptoms, diagnosis, prevention, management, rehabilitation, return to duty, and future directions for stress fracture in military populations. A literature search in PubMed/MEDLINE and Google Scholar identified 35 English-language studies used in the final narrative synthesis. Existing data indicate a load-capacity model involving dynamic relationships among external mechanical dose, local skeletal strain, and biological repair capacity. Factors contributing to susceptibility are a history of stress fracture, being female, age, menstrual malfunction, pre-entry conditioning, poor body composition, lack of vitamin D, exposure to medication, and site-specific biomechanics. In cases of negative radiographs and a high rate of clinical suspicion, such as activity-related and localized early symptoms, advanced imaging, including MRI, is the choice. Implement site-specific management, with greater protection and surgical attention for high-risk fractures. Rehabilitation should depend on pain-free work, strength recovery, progressive exposure to impact, and signs of healing rather than time. Prevention should focus on pre-entry conditioning, gradual training loads, adequate rest, adequate nutrition, and early symptom reporting. Future studies should test dynamic prediction models that integrate skeletal imaging, load measures from wearables, and known fracture outcomes to inform prevention and safe return to military service at the individual level.
SN - 2168-8184
ER -